surgery year 5 27feb 2012 1.

Acute appendicitis:

A. A causes pain in the umbilical area, which moves to the right iliac fossa (RIF) B. Is excluded if WCC and temperature are normal C. Is mistaken for ovarian cyst rupture D. Is treated by laparoscopic appendicectomy E. Mimics mesenteric adenitis

Answers:

A. True: Symptom of appendicitis is peri-umbilical colic and pain shift to the right iliac fossa (Bailey and Love Short Practice of Surgery 25th Edition, page 1208, Summary box 67.2)

B. False: However, in 20% of patients, there is no pyrexia or tachycardia in the early stages (Bailey and Love Short Practice of Surgery 25th Edition, page 1208). Normal temperature is often present even with advanced appendicitis (Textbook of Surgery S. Das 6th Edition, page 908). In 90% of cases the white cell count is greater than 10,000 cells per mm3 (Bailey and Love Short Practice of Surgery 20th Edition, page 1095). It must be remembered that in case of normal total and differential WBC, the diagnosis of acute appendicitis should be questioned but not excluded. (Textbook of Surgery S. Das 6 th Edition, page 910)

surgery year 5 27feb 2012 Article with title of Conservative Treatment IN Acute

Appendicitis. (www.jnma.com.np/jnma/index.php/jnma/article/download/60/42 0)

C. True:

Treatment

for

acute

appendicitis

is

laparoscopic

appendicectomy (Bailey and Love Short Practice of Surgery 25 th Edition, page 1213)

D. True: Differential diagnosis for adult female. The most common diagnostic mimics are pelvic inflammatory disease (PID), Mittelschmerz, torsion or hemorrhage of an ovarian cyst (as a result of ovarian cyst rupture) (Bailey and Love Short Practice of Surgery 25th Edition, page 1210)

E. True: The disease is most commonly mistakes for acute appendicitis are acute gastroenteritis and mesenteric lymphadenitis in children (Bailey and Love Short Practice of Surgery 25th Edition, page 1209)

2. Common causes of small bowel obstruction in adults are:

A. Stricture due to rectal carcinoma B. Adhesions C. Meckels diverticulum D. Intussusception

surgery year 5 27feb 2012 E. Strangulated hernia

Answers: A. False: The organic causes of chronic large bowel obstruction in mural type is colorectal cancer.(Bailey and Love Short Practice of Surgery 25th Edition, page 1200 ) B. True: In western countries where abdominal operations are common, adhesion and bands are the most common cause of intestinal obstruction (Bailey and Love Short Practice of Surgery 25th Edition, page 1190) C. True: Meckels diverticulum is present in 2% population; it is situated on the anti-mesenteric border of the small intestineileum. The presence of a band between apex of diverticulum and the umbilicus may cause obstruction either by band itself or by a volvulus around it. ( Bailey and Love Short Practice of Surgery 25th Edition, page 1158-1159) The important complication may occur in a Meckels diverticulum is intestinal obstruction. In adult this is probably the most common complication. (Textbook of Surgery S. Das 6 th Edition, page 875)

D. False: The condition is encountered most commonly in children, with a peak incidence between 5 and 10 months of age. In most children, the intussusception is ileocolic. In adults, colocolic intussusception is common. intussusception in adults can cause large bowel obstruction (Bailey and Love Short Practice of Surgery 25th Edition, page 1189)

surgery year 5 27feb 2012 E. True: It is vital to distinguish strangulating from nonstrangulating intestinal obstruction because the former is surgical emergency. In cases of intestinal obstruction in which pain persists despite conservative management, even in the absence of the above signs (clinical features of strangulation are constant pain, tenderness with rigidity and shock), strangulation should be diagnosed. (Bailey and Love Short Practice of Surgery 25th Edition, page 1194) Causes of strangulation are external blood (hernial flow orifices, (volvulus,

adhesion/bands),

interrupted

intussusception), increased intraluminal pressure (closed-loop obstruction) and primary mesenteric infarction.( Bailey and Love Short Practice of Surgery 25th Edition, page 1189)

3. Ureteric calculi:

A. Produced pain that colicky in nature B. Analgesia is used to alleviate the pain C. Are predominantly triple phosphate D. Can be treated by lithotripsy E. Predispose to transitional cell carcinoma of the ureter

Answers:

surgery year 5 27feb 2012 A. True: The presence of a stone passing down the ureter often causes intermittent attacks of ureteric colic (Bailey and Love Short Practice of Surgery 25th Edition, page 1300) B. False: To alleviate spasm a dose of probanthin is may be required. (Textbook of Surgery S. Das 6th Edition, page 1089). Non-steroidal anti-inflammatory drugs such as diclofenac and indomethacin have replaced opiates as the first line of treatment of ureteric colic. (Bailey and Love Short Practice of Surgery 25 th Edition, page 1301) C. False: Majority of the ureteral stones are calcium oxalate stones. Due to spiky surface, oxalate stone is easily caught in the ureter (Textbook of Surgery S. Das 6th Edition, page 1087) D. True: Lithotripsy in situ - A stone in the part of the ureter that can be identified by imaging system of the lithotriper can be fragmented in situ (Bailey and Love Short Practice of Surgery 25 th Edition, page 1302) E. `False: Squamous carcinoma may occur in the urothelium that has undergone metaplasia, usually following chronic inflammation or irritation due to stone or schistosomiasis. (Davidsons Principle & Practice of Medicine 20th Edition page 513) Squamous cell cancer of the urinary tract constitutes less than 15% of the tumors of the renal pelvis and a smaller percentage of ureteral tumors and is often associated with chronic calculus disease and infection. (http://www.cancer.gov/cancertopics/pdq/treatment/transitionalcell/Heal thProfessional/page1/AllPages/Print)

4. A lump in the midline of the neck are:

surgery year 5 27feb 2012

A. Dermoid cyst B. Sebaceous cyst C. Thyroglossal cyst D. Branchial cyst E. Cystic hygroma

Answers: A. True: Common site for dermoid cyst is anywhere in midline or in the line of fusion (SRBs Manual of Surgery 3rd Edition, page 64) B. True: A sebaceous cyst can occur anywhere in the body but most commonly seen in those parts where there are plenty of sebaceous glands (Textbook of Surgery S. Das 6th Edition, page 100) C. True: It is usually a midline swelling except when it is below the thyroid cartilage where it may shift to one side, more commonly to the left (Textbook of Surgery S. Das 6th Edition, page 509) D. False: Branchial cyst is a painless swelling in the upper and lateral part of the neck (Textbook of Surgery S. Das 6th Edition, page 505) E. False: Sites of cystic hygroma is in the lower third of the neck in the posterior triangle of the neck is the commonest site (Textbook of Surgery S. Das 6th Edition, page 508)

5. Clinical features of acute pancreatitis include: A. Tetany

surgery year 5 27feb 2012 B. Paralytic ileus C. Vomiting D. Jaundice E. Pleural effusion

Answers: A. True: Tetany (periodic painful muscular spasm due to

hypocalcemia) is a sign for hypocalcemia. Laboratory studies may reveal leucocytosis, hypocalcemia and hyperglycemia (Harrisons Principles of Internal Medicine 18th Edition, page 2637) The Journal Of American medical Association on article name acute pancreatitis complicated by tetany - This case is reported, first, because it may be the only proved case of acute hemorrhagic pancreatitis complicated by low calcium tetany (the blood calcium level being 5.4 mg. per hundred cubic centimeters) and, light it throws on some of the problems of a disease about which little is known. -http://jama.jamanetwork.com/article.aspx?articleid=268112 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1465091/?page=1

B. True: Systemic gastrointestinal complication of acute pancreatitis is ileus aka paralytic ileus (Bailey and Love Short Practice of Surgery 25th Edition, page 1143 Table 64.5)

C. True: Nausea, repeated vomiting and retching are usually marked accompaniments (Bailey and Love Short Practice of Surgery 25 th Edition, page 1140) D. True: The two major causes of acute pancreatitis are biliary calculi which is occur in 50-70% of patients, and alcohol abuse which

surgery year 5 27feb 2012 accounts for 25% of cases. (Bailey and Love Short Practice of Surgery 25th Edition, page 1139). Mild icterus can be caused by biliary obstruction in gallstone pancreatitis. (Bailey and Love Short Practice of Surgery 25th Edition, page 1140)

E. True: A pleural effusion is present in 10-20% of patient (page 1140) and it is also one of local complication of acute pancreatitis (Bailey and Love Short Practice of Surgery 25 th Edition, page 1143, Table 64.5)

6. A fistula:

A. Arises from a blind-ending abscess cavity B. Will never heal spontaneously C. Connects two separate epithelial surfaces D. Is found in anal canal E. Gives rise to severe fluid and electrolytes losses

Answers: A. False: It is an abnormal communication between the lumen of one viscus to another or the body surface or between vessels. The answer in A is for sinus. (SRBs Manual of Surgery 3 rd Edition, page 25) B. False: In enterocutaneous or fecal fistula - Low-output fistulae can be expected to heal spontaneously, provided there is no distal

surgery year 5 27feb 2012 obstruction. (Bailey and Love Short Practice of Surgery 25 th Edition, page 1185) C. True: It is an abnormal communication between the lumen of one viscus to another or the body surface or between vessels. (SRBs Manual of Surgery 3rd Edition, page 25) D. True: A fistula in-ano (anal fistula) is a chronic communication, usually lined to some degree by granulation tissue, which runs outwards from the anorectal lumen to external opening on the skin of perineum (Bailey and Love Short Practice of Surgery 25 th Edition, page 1262)

E. True: In enterocutaneous of fecal fistula (An external fistula communicating with the caecum sometimes follows an operation for gangrenous appendicitis or draining of an appendix abscess) can be divided into those with a high output, more than 1 litre per day and low output, less than 1litre per day. High-output fistulae cause rapid dehydration hypoproteinaemia. Vigorous fluid replacement and nutritional support are essential. (Bailey and Love Short Practice of Surgery 25th Edition, page 1184-1185)

surgery year 5 27feb 2012

7) Carcinoma of the stomach is associated with : a) Blood group O b) Cigarette smoking c) Pernicious anaemia d) Iron deficiency anaemia e) Transcoelomic spread to the ovary a) False : Gastric mucosa of people with blood group A is more susceptible for carcinogens-diffuse type. Reference : Bailey and SRBs Manual surgery ms : 902 b)True : Smoking and alcohol precipitate the cancerous condition Reference : Bailey and SRBs Manual Surgery ms: 903 c)True : Pernicious anaemia increases chance of high-risk 6 times reference : SRBs Manual Surgery ms:903 d) False : it is more common seen in Pernicious anaemia e) True: it has an evidence of transcoelemic spread to the ovary namely Krukenbergs tumours reference : Bailey and Love ms: 1053

8) Carcinoma of the prostate : a) Occurs frequently in men aged over 65 years b) Responds to testosterone therapy c) Causes a rectal stricture d) Produces osteosclerotic secondary bone deposits e) Spreads to pelvic lymph nodes a) True : It is the most common malignant tumour in men over 65 years old reference : Bailey and Loves ms : 1380 b) True : Responds to Androgen receptor blocking agents like Flutamide, bicalutamide

surgery year 5 27feb 2012 reference : SRBs Manual Surgery ms : 1128 c) True : it can cause rectal stricture(stenosis) reference : Bailey and Loves ms: 1382 d) True: Production of osteosclerotic changes secondary to pelvic bone, lumbar vertebrae is common and can be detected on bone scan reference : Bailey and Loves ms : 1382 e) True : it spreads into the obturator lymph nodes, then to internal iliac lymph nodes

9) An abdominal aortic aneurysm: a) Is seen on a plain abdominal radiograph b) Presents with a collapsing pulse c) Is the result of syphilis d) Needs treatment when symptomatic e) Usually involves the renal arteries a) True : on Xray it will show eggshell calcification. Ultrasound is the commonly used stool to visualize aortic aneurysm, though Ct scan is more precise reference : SRBs Manual Surgery ms :205 b) False : Collapsing pulse is not associated with aortic aneurysm reference : SRBs Manual surgery c) True : Syphilis is one of the causes that resulted aortic aneurysm reference : SRBs Manual Surgery ms : 204 d) False : Repaired is required in asymptomatic type if diameter is over 5.5 on USG e) True : Both types, Infrarenal and suprarenal suggest involvement of renal arteries reference : SRBs Manual Surgery ms :204

surgery year 5 27feb 2012 10) A nasogastric tube : a) Should be used to protect respiratory function in all patients with severe head injury b) Should be spigotted c) Is used for feeding d) Is required in upper gastrointestinal bleeding to assess blood loss e) Is used in the treatment of large bowel obstruction a) False : it is contraindicated to assess nasogastric tube in patient severed from head injury (skull fracture) reference : Wikipedia + American journal b) True : It should be spigotted to a bung at the end of NG tube to see the content ( Free drainage c) True : It is used for feeding in some patients that unable to feed per oral due to paralysis and some babies with difficulties to drink milk. Reference : Bailey and Loves chapter General Intraoperative principles ms : 111 d) True : Assessment of upper gastrointestinal bleeding can be done using NG tube as NG lavage in case of acute GI bleeding e) False : Ng tube is used in the management of Small Bowel Obstruction rather than Large Bowel Obstruction reference : Wikipedia + American Medical Journal

11) The carcinoma of the oesophagus: a) Occurs most frequently in the middle third of the oesophagus b) Is predominantly squamous in type c) Is a complication of oesophagitis d) Is associated with alcohol intake e) Occurs in Plummer Vinson syndrome

surgery year 5 27feb 2012 a)True : about 50% of occurrences are seen in middle third, 33% in lower third, 17% in upper third reference : SRBs Manual Surgery ms: 858 b) True : Squamous type cell carcinoma is commonest type in India and Asian countries reference : SRBs Manual Surgery ms :858 c) True: Oesophagitis / Barrets oephagitis is the premalignant condition that resulted to oesophageal carcinoma, 10% from GERD reference : SRBs Manual Surgery ms : d) True : people who consume alcohol and tobacco are more likely to develop oesophageal carcinoma reference : SRBs Manual Surgery ms : 858 e) True : Plummer-Vinson syndrome is one of the etiology that contributes to oesophageal carcinoma

12) Deep vein thrombosis : a) Usually results from incompetent superficial veins b) Is prevented by heparin c) Is treated with heparin d) Is more common in malignancy e) Is diagnosed by duplex scanning

a)False : Varicose veins develop from incompetent superficial veins and perforating veins reference : SRBs Manual Surgery ms : 233 b) True : it is prevented by Low Molecular Weight Heparin 5000units subcutaneously 2 hours before surgery reference : SRBs Manual Surgery ms: 233 c) True : Initially high dose of heparin of 25000 units/day for 7 days is given. Then later patient is advised to continue with warfarin for 3-6 months reference : SRBs Manual ms :233

surgery year 5 27feb 2012

d) False : It is common in post-operative condition, following childbirth and also bedridden and long standing travelling reference : SRBs Manual Surgery ms : 231 e) True : Duplex scanning shows noncompressible vein which is wider than normal reference : SRBs Manual Surgery ms : 233

surgery year 5 27feb 2012

13. In gastric ulceration: A. Malignant change eventually supervenes. B. An hour-glass stomach may occur. C. NSAIDs is one of the causes. D. Carbenoxolone sodium may promote healing. E. The majority of benign ulcers are situated in the greater curvature

Answer: A. TRUE; chronic duodenal ulcers are not associated with malignancy but, in contrast, gastric ulcers are. ( B&L, pg 1055) B. TRUE; fibrosis, when it occurs, may result in the now rarely seenhourglass contraction of the stomach. (B&L, pg 1055) C. TRUE; H. pylori and NSAIDs are the important aetiological factors in gastric ulceration. D. TRUE; Carbenoxolone sodium has been shown to cause significant healing of benign gastric ulcers. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1552826/?page=1, first paragraph) E. FALSE; chronic gastric ulcers are much more common on the lesser curve. ( B&L, pg 1055

14. With regard to haemorrhoids: A. Thrombosis is a recognized complication. B. Is treated with band ligation. C. First degree piles are best treated with haemorrhoidectomy. D. They predispose to carcinoma E. Strangulation is treated with haemorrhoidectomy.

surgery year 5 27feb 2012 Answer: A. TRUE; complications of haemorrhoids include strangulation and thrombosis, ulceration, gangrene, portal pyaemia and fibrosis. (summary box 69.9, Bailey & Love, page 1255)

B. TRUE; treatment of haemorrhoids include symptomatic-give advice about defaecatory habits, stool softeners and bulking agents; injection sclerosant; banding; haemorrhoidectomy. (summary box 69.10, B&L, pg 1257)

C. FALSE; In those with first and second degree piles, injection sclerotherapy, the submucosal injection of 5% phenol in arachis oil or almond oil may be advised.( B&L, pg 1256)

D. FALSE; (not mentioned in any literature)

E. TRUE; initially, conservative treatment is tried. Later in 4-5 days, haemorrhoidectomy is done. Doing haemorrhoidectomy immediately may precipitate portal pyaemia and anal stricture. ( SRB, 3 rd ed, pg. 911)

15. Recognized modes of presentation of gallstone include: A. Dysphagia B. Abdominal pain C. Shoulder tip pain D. Small bowel obstruction E. Tenesmus

Answer: A. FALSE; dysphagia is the difficulty in swallowing, in gallstone disease, patient may develop dyspepsia, flatulence, food intolerance,

surgery year 5 27feb 2012 particularly to fats, and some alteration in bowel frequency not dysphagia. ( B&L, pg 1120) B. TRUE; biliary colic is spasmodic pain, in RUQ and epigastrium, radiating to chest, upper back and shoulder. (SRB, 3 rd ed, pg 574) C. TRUE; please refer above D. TRUE; a gallstone can lead to bowel obstruction (gallstone ileus) but this rare. (B&L, pg 1120) E. FALSE; (not mentioned in any literature

16. The incidence of breast cancer is higher in women who: A. Have already had breast cancer. B. Are young. C. Have breast-fed their children. D. Are obese. E. Have a family history of ovarian carcinoma. Answer: A. TRUE; carcinoma in one breast increases the risk of developing carcinoma on opposite breast by 3-4 times. ( SRB, 3 rd ed, pg 467) B. FALSE; it is more common after middle age, but can occur at any age group, after 20 years. ( SRB, 3rd ed, pg 467) C. FALSE; early child bearing and breast feeding reduces the chances of malignancy. ( SRB, 3rd ed, pg. 467) D. TRUE; it is more common in obese individuals. ( SRB, 3 rd ed, pg. 467) E. TRUE; BRCA 1 predisposes to both breast and ovarian cancer in families. Therefore, if a person has family h/o ovarian cancer, there is increased risk to develop breast cancer as well. ( S. Das, Textbook of surgery, 7th ed, pg 606)

17. An undescended testis: A. Should be brought into the scrotum after the age of 10 years.

surgery year 5 27feb 2012 B. Is associated with inguinal hernia. C. Is prone to malignant change. D. Is more likely to undergo torsion than a normal testis. E. Means the patient will be sterile. Answer: A. FALSE; orchidopexy before 2 years of age improves fertility, may reduce the risk of malignancy and has psychological benefits. (B&L, pg 77) B. TRUE; an associated indirect herniaor interstial hernia is frequent with incompletely descended testis in 80% of the cases. ( S. Das Textbook of surgery, 7th ed, pg. 1307) C. TRUE; risk of malignancy is 50 times higher than that of a normally descended testis. ( S. Das Textbook of surgery, 7th ed, pg. 1307) D. TRUE; ( S. Das Textbook of surgery, 7th ed, pg. 1307) E. TRUE; in case of bilateral undescended testis, FALSE; in case of unilateral undescended testis. ( S. Das Textbook of surgery, 7 th ed, pg. 1307)

18. Staging of breast tumors: A. Assesses extent of spread. B. Indicated prognosis. C. Nodal involvement is a factor. D. Is performed by mammography. E. Is of use only in women. Answer:

surgery year 5 27feb 2012 A. TRUE; clinical staging is an attempt to identify the extent of the malignant lesion based on clinical examinations and special investigations. ( S. Das, Textbook of surgery, 7th ed, pg 615) B. TRUE; ( S. Das, Textbook of surgery, 7th ed, pg 615) C. TRUE; nodal involvement is one of the components of TNM staging. ( S. Das, Textbook of surgery, 7th ed, pg 616) D. TRUE; mammography is done to detect distant metastasis if present for proper clinical staging. ( S. Das, Textbook of surgery, 7 th ed, pg 617) E. FALSE; (not mentioned in any literature)

SURGERY 19) Crohns disease: A. B. C. D. E. Is associated with finger clubbing May cause protein malabsorption Is characteristically associated with dilatation of the terminal ileum Hardly ever affects the colon May undergo spontaneous symptomatic remission

surgery year 5 27feb 2012

Answer A. True; Finger clubbing is present in 75 out of 200 (38%) patients with Crohn's disease (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1596648/) B. True; It can cause protein malabsorption and nutritional deficiencies ( Manipal Manual of Surgery3rd edition page 565)

C. False; It is associated with stricture of terminal ileum ( Manipal Manual of Surgery 3rd edition page 565) D. False; commonly affects jejunum, ileum, colon, esophagus ( Manipal Manual of Surgery 3rd edition page 564)

E. False; It can cause obstruction due to stricture ( Manipal Manual of Surgery 3rd edition page 565)

surgery year 5 27feb 2012

20) A femoral hernia: A. B. C. D. E. Should be treated with a truss Has the femoral vein into it Contains omentum Appears above and medial to the inguinal ligament Can strangulate the bowel without obstructing it

Answer A) False; It cannot be controlled by a truss/ A truss is contraindicated in femoral hernia ( Bailey and Loves 25th edition page 979) B) True; Femoral vein is in the middle compartment of the femoral sheath ( Manipal Manual of Surgery 3rd edition page 691)

C) False; It contains hydrocele ( Bailey and Loves 25 th edition page 978) D) False; Appears lateral to pubic tubercle and below the inguinal ligament ( S.Das Clinical Surgery page 445)

E) False; can cause obstruction and strangulation ( Manipal Manual of Surgery 3rd edition page 692)

surgery year 5 27feb 2012

21) Surgical emphysema is caused by: A. B. C. D. E. Spontaneous pneumothorax Perforation of the esophagus Hyperventilation Traumatic pneumothorax Smoking

Answer A) False; Surgical emphysema is caused by tension pneumothorax, not by spontaneous pneumothorax (Bailey and Loves 25 th edition page 879 ) B) True; surgical emphysema is caused by perforation of esophagus (Bailey and Loves 25th edition page 879 ) C) True; hyperventilation can cause surgical emphysema (http://www.aana.com/newsandjournal/documents/subcutaneous_carb on0808_p282-285.pdf) D) True; A poorly managed chest drain or trauma to the chest can cause surgical pneumothorax ( Bailey and Loves 25 th edition page 879 )

E) False; Smoking is the cause of primary spontaneous pneumothorax

(http://err.ersjournals.com/content/19/117/217.full)

surgery year 5 27feb 2012 23) Volvulus : A. B. C. D. E. Causes venous infarction of the bowel Causes peritonitis Is cured by performing a barium enema Occurs only in the sigmoid colon Commonly occurs in children and young adults

Answer: A) True; Venous and lymphatic obstructions occur first because of lower intravascular pressures ( http://emedicine.medscape.com/article/930576-overview#a0104 ) B) True; Peritonitis is one of the complications of volvulus ( http://emedicine.medscape.com/article/930576-overview#a0104 )

C) False; Barium enema is use for diagnosis of volvulus ( Manipal Manual of Surgery 3rd edition page 604 ) D) False; May involve the small intestine, caecum or sigmoid colon. ( Bailey and Loves 25th edition page 1192 )

E) False; midgut volvulus commonly occurs in infants while sigmoid volvulus commonly occurs in elderly patients (http://emedicine.medscape.com/article/930576-overview#a0101)

surgery year 5 27feb 2012

24) Dukes staging of colorectal carcinoma : A. Involves assessment of lymph node spread B. Required assessment of the depth to tumour penetration through the wall of the bowel C. Involves assessment of the presence or absence of metastases in distant organs. D. Is made post mortem E. There are five stages

Answer A) True; Dukes staging C assess the lymph nodes involvement in colorectal carcinoma (Bailey and Loves 25th edition page 1230) B) True; Dukes B assess the extension of the tumour to the extrarectal tissues (Bailey and Loves 25th edition page 1230) C) True; Dukes D signifies the presence of widespread metastases, usually hepatic (Bailey and Loves 25th edition page 1231) D) False; aTNM staging determined via post mortem autopsy not by Dukes staging (http://www.suttermedicalfoundation.org/remoteaccess/ajcc/files/01%2 0Purpose%20and%20Principles%20of%20Cancer%20Staging.pdf ) E) False; There are 4 stages in Dukes staging of colorectal carcinoma (Bailey and Loves 25th edition page 1230)

surgery year 5 27feb 2012

22) Metastases in bone are a common feature of carcinoma of: A. B. C. D. E. The kidneys The rectum The lungs The stomach The thyroid

Answer; A) True; can spread to bones through hematogenous spread ( Manipal Manual of Surgery 3rd edition page 763) B) False; Usually involves prostate, seminal vesicles and bladder ( Manipal Manual of Surgery page 631)

C) True; Affecting 30-40% of people with lung cancer (http://lungcancer.about.com/od/typesoflungcance1/a/Lung-CancerWith-Bone-Metastases.htm) D) False; Usually involves liver, pancreas, spleen, omentum, and transverse colon ( Manipal Manual of Surgery 3 rd edition page 421 )

E) True; commonly, secondaries develop in the flat bones such as skull, ribs, sternum, and vertebral column because the flat bones retain red marrow for a longer time ( Manipal Manual of Surgery 3 rd edition page 300)

surgery year 5 27feb 2012

25. A full-thickness burn of the right leg: A. Is estimated to represent 5% of the entire body surface area B. May cause peptic ulcer C. May result in thrombosis D. Is treated by resuscitation with intravenous fluid E. Should be covered with ice

Answer A. False Full thickness burns on right leg compartment is 6%. (Bailey and Loves Short Practice of Surgery, 25th Edition. Burns. Page 382)

B. False Only happened in burn which involved >30% of body surface (large burn). Increased leakage of fluid from capillaries, and subsequent tissue edema causes overall blood volume loss, with the remaining blood suffering significant plasma loss, blood become more concentrated. Poor blood flow to organs such as kidney and GIT may result in renal failure and stomach ulcer. (PorthPathology: Concepts of Altered Health States. 1st Edition. Page 1516)

C. True Blood clotting in veins of leg is estimated to occur in 6-25% of people. (Schwartz's principles of surgery.9th Edition. Chapter 8:Burns)

D. True (Bailey 25th Edition. P382)

E. False Cold water bath (Manipal Manual of Surgery. 3rd Edition. Page 152)

26. Intussusception A. In infants usually require resection of the bowel

surgery year 5 27feb 2012 B. Presents with bowel obstruction C. Causes bleeding from the bowel D. Is twisting of the bowel E. Is treated with barium enema Answer A. False Hydrostatic reduction is done. (Manipal Manual of Surgery. 3 rd Edition. Page 613)

B. True Obstruction with bilious vomiting. (Bailey 25 th Edition. Page 80. Paed surgery)

C. True Due to mucosal ulcer causing red currant jelly stool. (Manipal Manual of Surgery. 3rd Edition. Page 613)

D. False It is INVAGINATION of one segment of bowel into another (Manipal of Surgery. Page 79)

E. False Barium enema is diagnostic (Manipal Manual of Surgery. 3rdEdtion. Page 80)

27. Acute extradural haemorrhage A. Causes a rise in pulse rate B. Causes rise in BP C. Results in hemiparesis D. Is associated with a dilated pupil on the side of the injury E. Can be distinguished from subdural haemorrhage by CT Answer: A. True Initially Tachycardia which may progress to bradycardia (Manipal Manual of Surgery. 3rd Edition. p835)

surgery year 5 27feb 2012 B. True Systolic blood pressure increases. Haemorrhage can also cause by hypertension. So, initially there will be rise in BP before patient going into shock. Cushings Triad. (Manipal Manual of Surgery. P835, website http://www.nature.com/jhh/journal/v18/n3/full/1001647a.html, and Medscape)

C. False More common is contralateral hemiplegia. (Bedside Clinics in Surgery by MakhanLalSaha. Page 517, http://www.byedr.com/medicine/479-byedr-2.html)

D. True Initially it is constriction of pupil which is transient. Ipsilateral dilatation. (Manipal Manual of Surgery. Page 834)

E. True Extradural appear as biconvex density while subdural appear as crescent shape hyperdense area. (Bedside Clinics in Surgery by MakhanLalSaha. Page 518-519)

28. Hepatitis B A. Is transmitted by faecal-oral route B. Vaccine should be given to at-risk healthcare workers C. Predisposes to hepatocellular carcinoma D. Causes liver cirrhosis E. Is an RNA virus Answer: A. False transmitted by parenteral, perinatal and sexual route (Textbook of Microbiology) B. True Common sense (http://www.who.int/mediacentre/factsheets/fs204/en/) C. True Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis.(Robbins &Cotran Pathologic Basis of Disease (7th ed.) pp. 9147)

surgery year 5 27feb 2012 D. TrueIn chronic infection (Hepatitis B virus infection".Semin Fetal Neonatal: page 160167) E. False DNA virus (Textbook of Microbiology) 29. Thyroid carcinoma A. Of the papillary type usually affects young adult B. Presents as a lump in the neck that moves on swallowing C. Of the anaplastic type carries the best prognosis D. Of the medullary type is a tumour of parafollicular cells E. Typically causes thyroid dysfunction

Answer: A. True - It occurs more frequently in women and presents in the 20-55 year age group. It is also the predominant cancer type in children with thyroid cancer (Manipal Manual of Surgery. 3 rd Edition. Page 296)

B. True Thyroid swelling moves with deglutition. (Bedside Clinics in Surgery by MakhanLalSaha. Page 201)

C. False Papillary carcinoma of thyroid is most common and has the best prognosis compared to all thyroid carcinoma. (Bailey and Loves Short Practice of Surgery, http://en.wikipedia.org/wiki/Thyroid_cancer on prognosis of thyroid cancer)

D. True It arises from parafollicular cells (Manipal Manual of Surgery. Page304)

E. False - Papillary thyroid carcinoma is usually discovered on routine examination as an asymptomatic thyroid nodule that appears as a neck mass. In some instances, the mass may have produced local symptoms (http://en.wikipedia.org/wiki/Papillary_thyroid_cancer on diagnosis)

surgery year 5 27feb 2012 30. The level of amylase in serum is typically raised in patients with: A. Acute pancreatitis B. Acute appendicitis C. Renal failure D. Perforated peptic ulcer E. Acute cholecystitis

Answer: A. True Serum amylase may be normal (in 10% of cases) for cases of acute or chronic pancreatitis (UK guidelines for the management of acute pancreatitis. Gut. 54 Suppl 3 (Suppl 3): iii19)

B. False (http://www.gpnotebook.co.uk/simplepage.cfm? ID=1852506167 causes of elevated serum amylase)

C. TrueDue to reduce excretion (http://annals.org/article.aspx?

articleid=692820 article by J. EDWARD BERK, M.D.; LOUIS FRIDHANDLER, Ph.D.; and RUSSELL L. NESS, M.D

D. False Occur in perforated duodenal ulcer (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1852506167)

E. True One of the common causes of elevated serum amylase (http://www.wisegeek.com/what-are-the-causes-of-high-amylaselevels.htm)